CVPath Institute, Inc, Gaithersburg, Maryland 20878, USA.
J Am Coll Cardiol. 2010 Apr 20;55(16):1679-87. doi: 10.1016/j.jacc.2010.01.021.
Using human pathologic specimens from the CVPath registry, we aimed to investigate the location of the atherosclerotic plaque at bifurcation in native coronary atherosclerotic lesions and to determine the responses at bifurcation after implantation of bare-metal stents (BMS) and drug-eluting stents (DES).
Greater atherosclerotic plaque burden has been reported to occur at low-shear regions of bifurcation.
Twenty-six randomly selected human atherosclerotic nonstented coronary bifurcation lesions were examined longitudinally for plaque distribution in patients dying of severe coronary artery disease. Forty stented bifurcation lesions (21 BMS and 19 DES) were reviewed and analyzed by morphometry.
In nonstented coronary bifurcations, the lateral wall showed significantly greater intima as well as necrotic core thickness than the flow divider. In the stented lesion, the frequency of late stent thrombosis was greater in the DES group (75%) than in the BMS group (36%), whereas restenosis was more frequent in the BMS group (33%) than in the DES group (5%). Neointimal formation was significantly less at the flow divider compared with the lateral wall in the DES group (0.07 mm [interquartile range (IQR) 0.03 to 0.15 mm] vs. 0.17 mm [IQR 0.09 to 0.23 mm]; p = 0.001), whereas this difference was not significant in the BMS group. Similarly, uncovered struts and fibrin deposition was significantly greater at the flow divider compared with the lateral wall in the DES group (uncovered: 40% [IQR 16% to 76%] vs. 0% [IQR 0% to 15%]; p = 0.001; fibrin: 60% [IQR 21% to 67%] vs. 17% [IQR 0% to 55%]; p = 0.01), but not in the BMS group.
Plaque formation in native coronary bifurcations and neointimal growth after DES implantation was significantly less at the flow divider versus the lateral wall. A higher prevalence of late stent thrombosis in DES compared with BMS was associated with greater uncovered struts at flow divider sites, which is likely due to flow disturbances.
使用 CVPath 注册中心的人体病理标本，我们旨在研究原发性冠状动脉粥样硬化病变中分叉处粥样斑块的位置，并确定裸金属支架（BMS）和药物洗脱支架（DES）植入后分叉处的反应。
据报道，在分叉的低切变区域发生的动脉粥样硬化斑块负担更大。
对 26 例死于严重冠状动脉疾病的患者的非支架冠状动脉分叉病变进行了 26 例随机选择的人粥样硬化非支架冠状动脉分叉病变的纵向斑块分布检查。通过形态计量学对 40 个支架分叉病变（21 个 BMS 和 19 个 DES）进行了回顾性分析。
在非支架冠状动脉分叉处，外侧壁的内膜和坏死核心厚度明显大于分流器。在支架病变中，DES 组晚期支架血栓形成的频率（75%）明显高于 BMS 组（36%），而 BMS 组的再狭窄率（33%）明显高于 DES 组（5%）。DES 组在分流器处的新生内膜形成明显小于外侧壁（0.07 毫米[四分位距（IQR）0.03 至 0.15 毫米]比 0.17 毫米[IQR 0.09 至 0.23 毫米]；p = 0.001），而 BMS 组无显著差异。同样，DES 组在分流器处的未覆盖支架和纤维蛋白沉积明显大于外侧壁（未覆盖：40%[IQR 16%至 76%]比 0%[IQR 0%至 15%]；p = 0.001；纤维蛋白：60%[IQR 21%至 67%]比 17%[IQR 0%至 55%]；p = 0.01），但 BMS 组无显著差异。
与外侧壁相比，在原生冠状动脉分叉处的斑块形成和 DES 植入后的新生内膜生长在分流器处明显减少。DES 与 BMS 相比，晚期支架血栓形成的发生率更高，这与分流器部位更大的未覆盖支架有关，这可能是由于血流紊乱所致。
